Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | OR |
NPI | 1053930065 |
---|---|
Provider Name | Verenis Estrada |
First Address | Fairview, OR 97024-1817 |
Second Address | Portland, OR 97211-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 15/04/2020 |